Feasibility and acceptability of suicide prevention therapy on acute psychiatric wards : randomised controlled trial

Haddock, Gillian and Pratt, Daniel and Gooding, Patricia and Peters, Sarah and Emsley, Richard and Evans, Emma and Kelly, James and Huggett, Charlotte and Munro, Ailsa and Harris, Kamelia and Davies, Linda and Awenat, Yvonne (2019) Feasibility and acceptability of suicide prevention therapy on acute psychiatric wards : randomised controlled trial. BJPsych Open, 5 (1): e14. pp. 1-8. ISSN 2056-4724

Abstract

Background: Suicidal behaviour is common in acute psychiatric wards resulting in distress, and burden for patients, carers and society. While psychological therapies for suicidal behaviour are effective in outpatient settings, there is little research on their effectiveness for suicidal inpatients. Aims: Our primary objective was to determine whether Cognitive Behavioural Suicide Prevention therapy (CBSP) was feasible and acceptable, compared to treatment as usual (TAU) for suicidal inpatients. Secondary aims were to assess impact of CBSP on suicidal thinking, behaviours, functioning, quality of life, service use, cost-effectiveness and psychological factors associated with suicide. Methods: A single-blind pilot RCT comparing TAU to TAU plus CBSP in suicidal inpatients in acute psychiatric wards (the INSITE trial). The intervention consisted of TAU plus up to 20 CBSP sessions, over 6 months continuing in the community following discharge. Participants were assessed at baseline, and at 6 weeks and 6 months post-baseline. Results: Fifty-one individuals were randomised (27 to TAU, 24 to TAU plus CBT) of whom 37 were followed up at 6 months (19 in TAU, 18 in TAU plus). Engagement, attendance, safety and user feedback indicated that the addition of CBSP to TAU for acutely, suicidal inpatients was feasible and acceptable whilst on inpatient wards and following discharge. Economic analysis suggests the intervention could be cost effective. Discussion: Psychological therapy can be delivered safely to suicidal inpatients although modifications are required for this setting. Findings indicate a larger, definitive trial should be conducted.